破裂脑动脉瘤栓塞时机与术后蛛网膜下腔出血的治疗

The optimal time of endovascular embolization and the treatment of post-operation subarachnoid hemorrhage in patients with ruptured intracranial aneurysm

目的探讨破裂性颅内动脉瘤血管内栓塞的时间与术后蛛网膜下腔出血（subarachnoid hemorrhage，SAH）的治疗。方法西安交通大学医学院第一附属医院神经外科对118例破裂性颅内动脉瘤患者在发病后7d内用电解可脱性弹簧圈（guglielmidetachablecoil，GDC）进行动脉瘤囊内栓塞。术后早期处理已经聚积在蛛网膜下腔的出血，以及由于SAH而导致的脑部及全身性并发症。治疗效果经f检验。结果118个动脉瘤中101个瘤腔100％闭塞，12个95％闭塞，5个被90％闭塞。术后115例临床痊愈，其治疗结果根据Glasgow预后评分：Ⅰ级89例，Ⅱ级14例，Ⅲ级9例，Ⅳ级3例，V级3例。全组死亡3例，死亡率2．5％。术中并发脑血管痉挛8例，动脉瘤破裂3例，GI）C脱出2例，脑梗塞1例。术后74例随访6～72个月均无再出血，3例复发者经二次补充GDC栓塞治愈。结论对破裂性动脉瘤应早期进行血管内栓塞。术后治疗的策略应着眼于早期处理SAH。防治脑血管痉挛及延迟性缺血性神经功能障碍，并妥善处理脑部与全身并发症。

Objective To explore the optimal time of endovascular embolization and the treatment of postoperation subamchnoid hemorrhage （SAH） in patients with ruptured intracranial aneurysm. Method Endovascular embolization with Guglielmi detachable coil was used in 118 patients with ruptured intracranial aneurysm within 7 days after onset. At the early phase after operation, SAH and its complications were treated. The patients were from the First Afllilated Hospital of Medical college, Xi＇ an Jiaotong University. The data were analyzed by X^2 test. Results Among the 118 aneurysms, 101 tumor cavity were totally embohzed, 12 tumor cavity were 95% embolized, and 5 tumor cavity were 90% embohzed. A total of 115 patients recovered. According to the Glasgow prognosis score, 89 patients were classified in grade Ⅰ, 14 in grade Ⅱ, 9 in grade Ⅲ, 3 in grade Ⅳ, and 3 in gradeⅤ. Three patients died, with mortality 2.5 %. During the operation, 8 patients were complicated with cerebral vasospasm, 3 with intraeranial aneurysm rupture, 2 with GDC off, and 1 with cerebral infarct. A total of 74 patients were followed up for 6 to 72 months, and hemorrhage didn＇ t reoccurred. Hemomhge reoecured in 3 patients and they were cured by the second embohzation. Conclusions The endovascular embolization should be carried out early for ruptured intracranial aneurysm. The operation, SAIl should be treated, cerebral vasospasm and delayed ischemic neurological deficit should be prevented, and cerebral and systemic complications should be treated.